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1. OWNER INFORMATION u U �'7-; �` li 1IJ ,v/ <br />Name Mel Bokides Petroleum, Inc. <br />Address P.O. Box 914, Lodi, CA 95241 SEP 2 0 2002 Phone# 209-472-3491 <br />Contact Nick Bokides <br />2. FACILITY INFORMATION PERMIT/SERVICES <br />Name MBP Mossdale <br />Address `444 Mossdale Road, Lathrop, CA 95330 Phone # 209-234-1256 <br />Contact Nick Bokides <br />4. TESTING CONTRACTOR INFORMATION <br />Name Walton Engineering, Inc. Lie#/Class 617238 A, B, Haz <br />Contact Michael Walton Phone # 916-373-1152 <br />Address P.O. Box 1025, West Sacramento, CA 95691 <br />Test Technician James Da <br />5. SUMMARY OF TEST RESULTS <br />Number of Tanks Tested <br />Number of Piping Sumps Tested <br />1 <br />3 <br />Number of Piping Runs Tested 3 <br />Number of UDC Boxes Tested 6 <br />Component <br />Pass Fail <br />Comments <br />Annular - Tank #1 <br />Gasoline - 87 <br />• <br />O <br />Annular - Tank #2 <br />Gasoline - 91 <br />2nd compartment of a 3 compartment tank. No testing performed. <br />Annular - Tank #3 <br />Diesel <br />3rd compartment of a 3 compartment tank. No testing performed. <br />Secondary Pipe #1 <br />Gasoline - 87 <br />• <br />O <br />Secondary Pipe #2 <br />Gasoline - 91 <br />• <br />O <br />Secondary Pipe #3 <br />Diesel <br />• <br />O <br />Piping Sump #1 <br />Gasoline - 87 <br />• <br />O <br />Piping Sump #2 <br />Gasoline - 91 <br />• <br />O <br />Piping Sump #3 <br />Diesel <br />• <br />O <br />U D C #1 <br />Disp # 1/2 <br />• <br />O <br />U D C #2 <br />Disp # 3/4 <br />• <br />O <br />U D C #3 <br />Disp # 5/6 <br />• <br />O <br />U D C #4 <br />Disp # 7/8 <br />• <br />O <br />U D C #5 <br />Disp # 9/10 <br />• <br />O <br />U D C #6 <br />Disp # 11/12 <br />• <br />O <br />Technician Signature , <br />Date 1 <br />